Remote Medical Director: Clinical Strategy & Appeals Lead

Ladders; United States; Remote; USD 213,000 - 354,000; Full time

Benefits offered by this job

Comprehensive medical, vision, and–d……

Company-paid life insurance

Tuition reimbursement

Paid time off & holidays

401(k) with company contributions

Well-being and behavioral health

Job summary

Ladders seeks a Medical Director to lead clinical decision-making for coverage and claims resolution in a remote US-based role. You will influence medical management initiatives, mentor teams, and support high-quality outcomes for members.

The position collaborates with healthcare professionals to balance service, cost, and regulatory compliance while driving medical management initiatives, appeals, mentoring, and continuous performance improvement across the organization.

Qualifications

• Current unrestricted medical license in a US state or territory.
• Board certification in ABMS- or AOA-recognized specialty.
• Minimum of 5 years of clinical practice or direct patient care experience beyond residency.

Responsibilities

• Conduct benefit-driven medical necessity reviews for coverage and claims resolution.
• Support quality outcomes for customers focusing on service and cost.
• Improve clinical outcomes through effective communication and negotiation with healthcare professionals.
• Advocate for customer and member needs while balancing business goals.
• Participate in the appeals process in compliance with regulatory standards.
• Help develop and maintain medical management projects and initiatives.
• Serve as a mentor to support quality and performance improvement efforts.

Skills

Clinical leadership

Regulatory understanding

Negotiation

Communication

Project management

Education

Medical license (US)

Board certification (ABMS/AOA)

Tools

Word processing

Spreadsheets

PowerPoint

EMR systems

Job description

Ladders seeks a Medical Director to lead clinical decision-making for coverage and claims resolution in a remote US-based role. You will influence medical management initiatives, mentor teams, and support high-quality outcomes for members.

The position collaborates with healthcare professionals to balance service, cost, and regulatory compliance while driving medical management initiatives, appeals, mentoring, and continuous performance improvement across the organization.